THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This project links with hundreds of health service delivery sites across the country in order to meet PEPFAR

targets in those areas. It also links to the Capacity Project in other program areas such as ARV Services

(#6919), Laboratory Infrastructure (#6920), and Systems Strengthening (#8693).

2. ACTIVITY DESCRIPTION

Emergency Hiring Plan (EHP): This project will assist in providing critical human resource management

support to ensure increased service delivery for realization of health outcomes with specific emphasis on

HIV/AIDS services at recipient sites. The availability and retention of trained health personnel, particularly in

the public health sector, is the cornerstone of Kenya's response to the health needs of the country and its

response to the HIV/AIDS epidemic. Currently, Kenya's public health sector and not-for-profit health

organizations are overwhelmed by the strain of coping with HIV/AIDS prevention, treatment, care and

support in addition to other priority health services. Their human resource systems are also unable to keep

up with requirements for HIV/AIDS program planning, management and implementation. This ground

breaking emergency hiring and training program seeks to increase resources in qualified human capital that

will be made available to Kenya's public health sector. In areas where the bulk of health care services

including ARVs are provided by facilities managed by faith-based organizations and where they are clearly

faced with staffing shortages, the program has attracted and deployed health workers in such facilities.

Specifically, this initiative will enhance the capacity of the public health sector in Kenya to initially expand

access to treatment and care for HIV/AIDS patients and also strengthen the provision of quality health

programs especially in rural priority posts. The project shall consider various approaches that hold promise

for enhancing and sustaining the local health workforce both in the short and long term. As such, this

initiative should be envisioned as a strategic and humanitarian intervention in a setting that currently lacks

sufficient and adequately qualified health workers to mount an effective counterattack on HIV/AIDS and

continue to provide other essential health services at the same time. All the available evidence seems to

suggest that without such reinforcement of critical cadres of human resources for health, PEPFAR as well

as the Ministry of Health's ambitious coverage and treatment targets for Kenya will be difficult if not

impossible to achieve. The objectives of this emergency hiring plan are: 1) to develop and implement a fast-

track hiring and deployment model that will mobilize 830 additional health workers and deploy them in the

public sector to urgently tackle the HIV/AIDS crisis; 2) to develop and implement an accelerated "crash

training program" that will rapidly address the gaps in skills and competencies for the new hires; and 3) to

design and implement a monitoring, quality assurance and support system that will enable health care

workers by site to increase their efficiency and effectiveness. After the successful recruitment and

deployment of 830 health providers to government and faith-based facilities in 2008/9 on three-year

contracts, this project will, in 2008/9, support the management of the new hires to fill critical gaps in

HIV/AIDS services. This includes support to facilities providing PMTCT services, and PMTCT clinics. The

PMTCT program area will support 58 nurses. Capacity will document and develop tools and initiatives that

will improve job satisfaction, supervision systems and retention for the new hires. The new hires' salaries

have been matched with Ministry of Health salaries by position and qualification and Capacity, through its

improved administration system, will continue to ensure the timely monthly payment of each hire until the

end of their three-year contract. In addition, the project will strengthen on-site monitoring and supervision

through its Workforce Mobilization Program which seeks to make simple, cost-effective changes to the

workplace that improve supervision, monitoring, and staff morale.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Capacity Project supports GOK and Mission service-delivery sites across the country by ensuring they have

the qualified staff they need to meet the patients' needs. The project maintains 830 health care providers at

facilities across the country, develops on-site supervision, and is working nationally to make these system

improvements sustainable. 58 nurses will be supported under PMTCT.

4. LINKS TO OTHER ACTIVITIES

This project links with hundreds of health service delivery sites across the country in order to meet PEPFAR

targets in those areas. It also links to the Capacity Project in other program areas such as ARV services,

Lab Infrastructure, and Systems Strengthening.

5. POPULATIONS BEING TARGETED

This project targets health care providers in the public sector, in particular nurses at facilities that provide

PMTCT.

6. KEY LEGISLATIVE ISSUES

Through the emergency hiring plan, staff hired will help address gender equity in HIV programming and

improve service delivery to pregnant women, their infants and spouses. The staff hired will also help

address male norms that often hinder access to critical services by women.

7. EMPHASIS AREAS

The major emphasis area for this project is Human Resources. The minor emphasis area is on Quality

Assurance and Supportive Supervision. The project, in managing EHP staff, seeks to improve on-site

supervision quality through its Workforce Mobilization Program.

1. ACTIVITY DESCRIPTION

This activity relates to all Capacity projects narratives in HTXS, HLAB, and OHPS.

Capacity has continued to support seconded staff to various Government ministries and under this program

area will provide support to an Advisor on Tuberculosis at the Ministry of Health based at the National

Leprosy and Tuberculosis Program (NLTP). This advisor will bring additional skills in tuberculosis

laboratory needs serving as an advisor to the NLTP on the needs of the various TB/HIV diagnostic sites.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Capacity supports 830 health care providers at facilities across the country, develops on-site supervision,

and is working nationally to make these system improvements sustainable. This activity will support a

senior Technical advisor at the MOH/NLTP to improve TB/HIV lab diagnostic.

3. LINKS TO OTHER ACTIVITIES

This activity links to all Capacity project activities that are involved in the hiring of health personnel as well

as seconding staff to the Ministry of Planning and National Development and the National AIDS and STI

Control Program (NASCOP).

4. POPULATIONS BEING TARGETED

This activity will strengthen TB diagnostic sites assisting in the appropriate testing of HIV positive persons

for Tuberculosis.

5. EMPHASIS AREAS / KEY LEGISLATIVE ISSUES ADDRESSED

The main emphasis area for this activity is local organization capacity building serving to strengthen the

National Leprosy and Tuberculosis Program (NLTP) by boosting the capacity to provide technical

assistance to TB diagnostic sites.

N/A (exempt)

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in ARV services (#6919), System Strengthening (#8693) and Prevention of

Mother To Child Transmission (#8647).

2. ACTIVITY DESCRIPTION

This activity supports the management, supervision, and administration of the 90 laboratory technicians

hired by Capacity to primarily government facilities. In addition to filling critical gaps in HIV/AIDS laboratory

services, the new hires support anti-retroviral therapy (ART) screening and monitoring, HIV care and

prevention services. This project assists in providing critical human resource management support to

ensure increased service delivery for better health outcomes, specifically in HIV/AIDS at recipient sites. The

availability and retention of trained laboratory personnel, particularly in the public health sector, is the

cornerstone of Kenya's response to the health needs of the country and its response to the HIV/AIDS

epidemic. Currently, Kenya's public health sector and not-for-profit health organizations are overwhelmed

by the strain of coping with HIV/AIDS prevention, treatment, care and support in addition to other priority

health services. Their human resource systems are also unable to keep up with requirements for HIV/AIDS

program planning, management and implementation. This ground breaking emergency hiring and training

program seeks to increase resources in qualified human capital that will be made available to Kenya's

public health sector. In areas where the bulk of health care services including ARVs are provided by

facilities managed by faith-based organizations and where they are clearly faced with staffing shortages, the

program has attracted and deployed health workers in such facilities. Specifically, this initiative will enhance

the capacity of the public health sector in Kenya to initially expand access to treatment and care for

HIV/AIDS patients and also strengthen the provision of quality health programs especially in rural priority

posts. The project shall consider various approaches that hold promise for enhancing and sustaining the

local health workforce both in the short and long term. As such, this initiative should be envisioned as a

strategic and humanitarian intervention in a setting that currently lacks sufficient and adequately qualified

health workers to mount an effective counterattack on HIV/AIDS and continue to provide other essential

health services at the same time. All the available evidence seems to suggest that without such

reinforcement of critical cadres of human resources for health, PEPFAR as well as the Ministry of Health's

ambitious coverage and treatment targets for Kenya will be difficult if not impossible to achieve. The

objectives of this emergency hiring plan are: 1) to develop and implement a fast-track hiring and deployment

model that will mobilize 90 additional laboratory workers and deploy them in the public sector to urgently

tackle the HIV/AIDS crisis; 2) to develop and implement training programs that will rapidly address the gaps

in skills and competencies for the laboratory workers; and 3) to design and implement a monitoring, quality

assurance and support system that will enable the laboratory workers at sites to increase their efficiency

and effectiveness. In 2007 and 2008, the Emergency Hiring Plan (EHP) will strengthen the health sector

systems to improve and sustain the new hires and facility performance to deliver the essential services.

Capacity will document and develop tools and initiatives that will improve job satisfaction, supervision

systems and retention for the new hires. The new hires salaries have been matched with the Ministry of

Health salaries according to position and qualifications and will be paid on time at the end of each month. At

the same time, Capacity will implement long-term human resource planning with the Ministry of Health. The

EHP can only generate sustainable results if its lessons and promising practices are taken up, applied and

combined with existing effective measures to address all the components of the Human Resources in

Health (HRH) Framework. It will be important to ensure appropriate skills amongst health workers to meet

the health needs of the Kenyan population, which means expansion of educational opportunities and

curricula reforms. With donor support, the MOH recently completed a three year Human Resource Strategic

Plan and implementation plan. The MOH will need to be encouraged and supported to take this strategic

initiative forward. This project will work with health sector leaders and primary stakeholders to strengthen

HRH within the national health system, assist the ministry to develop core technical capacity in HRH

planning, management and offer support by a) providing targeted technical assistance to assist the MOH

with the implementation of the 3 year HR strategic plan b) introducing an integrated human resource

information system (HR IS), c) streamlining and strengthening HR management processes and practices

especially recruitment, deployment, transfers, supervision and performance management and linking HR

and payroll data, d)enrolling selected HRH leaders and managers in a leadership development course, and

d) working with the OCPD on and MOH divisions to standardize curricula as needed, and e) expanding the

Work Climate Improvement Initiative that seeks to improve job satisfaction and aid retention, to sites with

new hires.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

Capacity will support the 90 laboratory personnel who will provide HIV and AIDS services to selected sites

across the country.

4. LINKS TO OTHER ACTIVITIES

Health care providers will be deployed to sites around Kenya with the greatest need in order to meet

PEPFAR targets in those areas. Most of these facilities are GOK facilities, and many are supported by

PEPFAR partners. This activity links to Capacity activities in other program areas as well: PMTCT (#8647),

ARV Services (#6919), System Strengthening (#8693).

5. POPULATIONS BEING TARGETED

This project targets laboratory technicians primarily in the public sector, and MOH policymakers, HR

administrators, and hospital supervisors.

6. KEY LEGISLATIVE ISSUES ADDRESSED

This activity will address the issue of increasing gender equity in HIV/AIDS programs.

7. EMPHASIS AREAS

The major emphasis area for this project is human resources as it manages and seeks to retain 90

laboratory personnel to scale up HIV/AIDS services. Minor emphasis areas are Policy and Guidelines and

QA/QI/SS, as Capacity will work with the MOH on implementation of its Human Resource in Health policy,

and seeks to improve on-site supervision through its Workforce Mobilization Program.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP are:

• Transitioning the EHP health workers into the GOK payroll.

• Promoting Task Shifting by rationalizing scopes of practice for existing health workers and also mobilizing

auxiliary cadres and delegating to them a controlled set of tasks.

• Developing and implementing innovative, low cost and locally relevant retention interventions at selected

sites, especially in hard-to-reach areas that are generally considered unattractive by health workers.

• Pursuing innovative approaches to increasing human resources for health, with a particular emphasis on

training youth, including as paramedical professionals, and utilizing retired health care workers.

• Sharing learning methods and models with pre-service institutions and reputable local training providers

so that relevant leadership and management programs can be efficiently adapted and applied.

• Providing management and technical support to the APHIA 2 NEP program in implementing innovative

staffing approaches to ensure the uptake of critical HIV and FP/RH services-especially at community levels.

• Training District Management Teams in national planning and budgeting

1. LIST OF RELATED ACTIVITIES

This activity relates to all facility-based service delivery projects. It also relates to Global Fund support under

the Futures Group/HPI project [HPI] in this same program area.

2. ACTIVITY DESCRIPTION

The Capacity Project will continue to implement long-term human resource planning with the Ministry of

Health. The Emergency Hiring Plan (EHP) can only generate sustainable results if its lessons and promising

practices are taken up, applied and combined with existing effective measures to address all the

components of the Human Resources in Health (HRH) Framework. It will be important to ensure

appropriate skills amongst health workers to meet the health needs of the Kenyan population, which means

expansion of educational opportunities and curriculum reforms. Kenya is also faced with a unique

absorptive capacity challenge: although it does not produce enough health providers to plug gaps in

coverage, it is also unable to find work for all its graduates, creating a "phantom surplus" of qualified,

unemployed health workers. Moreover, in most training schools, the curriculum is misaligned with the

country's health problems (for example, HIV/AIDS is not adequately covered), and pedagogic methods are

outdated, excluding practical problem-solving skills. Training and production of health workers is based not

on working competencies but on certification or traditional roles that are often controlled by and aligned to

the goals of professional bodies. This activity will strengthen three key aspects of long-term human

resources development in Kenya through: 1) support to the Ministry of Health's division to standardize their

HIV/AIDS curricula, 2) assistance to the Office of Continuing Professional Development (OCPD) to develop

the National Health Training Plan (NHTP), and 3) support for the development of a computerized database

of national health worker information and training participation, towards a goal of developing an

accreditation program of curricula and continuing medical education credits. The Capacity Project will also

provide focused technical assistance to the Global Fund as well as capacity building of the Country

Coordinating Mechanism (CCM) Secretariat. While it is essential to mobilize additional health workers to

avert the current workforce crisis and help combat priority diseases like HIV/AIDS, it is as important to help

develop and sustain policies and strategies over the longer term. All of these activities will be done in close

collaboration with the Ministry of Health (MOH). With donor support, the MOH recently completed a three

year Human Resource Strategic Plan and implementation plan. The MOH will need to be supported to take

this strategic initiative forward. In addition to the EHP, this year the project will work with health sector

leaders and primary stakeholders to strengthen HRH within the national health system, assist the Ministry to

develop core technical capacity in HRH planning and management and offer support by a) providing

targeted technical assistance to assist the MOH with the implementation of the 3 year HR strategic plan, b)

introducing an integrated human resource information system, c) streamlining and strengthening HR

management processes and practices especially recruitment, deployment, transfers, supervision and

performance management and linking HR and payroll data, d) enrolling selected HRH leaders and

managers in a leadership development course, e) supporting the OCPD to develop the NHTP and training

database, and f) expanding the Work Climate Improvement Initiative that seeks to improve job satisfaction

and aid retention, to sites with new hires. Secondly, the Capacity Project continues to support seconded

staff, and under this program area, will support the Advisor for HIV/AIDS Mainstreaming at the Ministry of

Planning and National Development (MPND). This person provides pivotal technical assistance by

supporting various arms of the government including the National AIDS Control Council (NACC) and the

National AIDS and STD Control Program (NASCOP) to engage in the national budgeting process with the

goal of increasing allocations for HIV and AIDS activities. The Advisor also provides technical assistance to

MPND to accelerate the agenda of mainstreaming HIV/AIDS through the national Poverty Eradication

Strategy (PRSP) in the public sector, and provides critical technical input into the collection and

management of data systems at the Central Bureau of Statistics that captures and addresses the national

level impact and mitigation strategies against the effects of HIV and AIDS. Lastly, the Capacity Project will

allocate $250,000 of its Systems Strengthening budget for support the Global Fund Country Coordinating

Mechanism (CCM) in Kenya with the implementation of the Transition Team Action Plan and management

of Global Fund grants. The GFATM has established transparent disbursement procedures, project

implementation modalities, oversight responsibilities, and financial and program performance reporting

responsibilities to ensure Principal Recipient (PR), CCM and sub-recipient accountability to the Government

of Kenya and to the GFATM. There are basic conditions which a country must meet before funds are

released for the approved projects. In Kenya, the Ministry of Finance is the PR and the performance of all

the major grants that fall under its purview has been unsatisfactory. The Capacity Project will provide

technical assistance to improve the management and implementation of these grants, including support to

the CCM secretariat. This might include recruitment of secretariat staff and meeting the costs of establishing

a web-based database of appropriate GF and CCM material such as approved meeting minutes, proposals

and other documentation.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

The Capacity Project will contribute policy-level guidance on the critical processes of health planning and

management in support of national level goals and ensure sustainability of PEPFAR-supported hiring and

training activities.

4. LINKS TO OTHER ACTIVITIES

Activity Narrative: This project links with hundreds of health service delivery sites across the country to meet PEPFAR targets

in those areas.

5. POPULATIONS BEING TARGETED

This activity targets government policy makers to improve the planning and management of human

resources, and implementation and development of HRH policies and systems at the national level, and

also works with HR and OCPD staff to develop their capacities. The USG and its collaborating agencies are

under continuous pressure to hire highly experienced professionals to guide PEPFAR-supported programs.

As a result, we have hired away over a dozen of the MOH's most qualified personnel. Many of these staff

have over 15 years experience in health management and their loss to the MOH has resulted in the

weakening of capacity of the very system that PEPFAR is pledging to build. Making matters worse, at the

same time that there are increasing shortages of senior health managers, there are deteriorating working

conditions and growing demand to incorporate new and labor-intensive services, such as antiretroviral

therapies for HIV/AIDS. We propose to help address these issues through the development of an intensive

program of management strengthening and staff development within the MOH and, more specifically,

NASCOP. This corresponds with a similar program being undertaken with the Kenya Medical Supplies

Agency (KEMSA) under the Millennium Challenge Account Threshold Agreement.

6. TARGETS

Number of local organizations provided with technical assistance for HIV-related policy development- 3

(NASCOP, MPND, DRH)

Number of local organizations provided with technical assistance for HIV-related institutional capacity

building-118 (NASCOP, MPND, DRH, AMREF, 114 districts)

Number of individuals trained in HIV-related policy development (Not applicable)

Number of individuals trained in HIV-related institutional capacity building-114

Number of individuals trained in HIV-related stigma and discrimination reduction- 690

Number of individuals trained in HIV-related community mobilization for prevention, care and/or treatment-

690